Objective To evaluate the effectiveness of the shared decision-making scheme in postoperative out-of-hospital extended care for patients with total hip/knee arthroplasty (THA/TKA). Methods Patients who underwent THA/TKA in the Department of Orthopedic Surgery at West China Hospital of Sichuan University between October 2023 and April 2024 were included using convenience sampling. Patients were divided into the control group (odd-numbered dates) and the intervention group (even-numbered dates) based on the surgical dates. The intervention group was received care guided by a shared decision-making protocol, whereas the control group was followed the standard post-arthroplasty follow-up procedures. Differences between the two groups were compared in terms of decision-making capacity, decision satisfaction, and hip/knee function at the following time points: on the day of discharge, 3 weeks after discharge, 2 months after discharge, and 3 months after discharge. Results A total of 118 patients were included, with 59 cases in each group. There were no significant differences in demographic and clinical characteristics between the two groups (P>0.05). In terms of decision-making, compared with the control group, the experimental group had stronger decision-making ability, lower decision-making conflict, and more satisfaction with the decision-making process (P<0.05). In terms of joint function, the experimental group showed better joint function than the control group at 3 weeks, 2 months, and 3 months after surgery (P<0.05). There was no significant difference in the pain dimension of the Western Ontario and McMaster Universities Osteoarthritis index between the two groups (P=0.199). Conclusions Compared with the traditional follow-up protocol, the shared decision-making protocol can enhance patient engagement in medical decision-making, reduce decisional conflict, improve satisfaction with the decision-making process, and simultaneously promote joint functional recovery and expedite the rehabilitation process.
Objective To compare the short-term result between the high-flex (HF) and conventional posteriorstabil ized (PS) prosthesis in total knee arthroplasty (TKA). Methods From April 2005 to October 2007, 23 cases (27 knees) underwent TKA by HF prosthesis (HF group), and 35 cases (41 knees) underwent TKA by PS prosthesis (PS group).In HF group, there were 2 males (3 knees) and 21 females (24 knees) aged (64.3 ± 5.6) years, including 20 cases (23 knees) of osteoarthritis and 3 cases (4 knees) of rheumatoid arthritis; body mass index (BMI) was 27.3 ± 3.9; the course of disease was (5.3 ± 5.6) years; the Hospital for Special Surgery Scoring System (HSS) score was 58.4 ± 7.9; the Western Ontario and McMaster universities osteoarthritis index (WOMAC) score was 49.4 ± 6.9; the maximum knee flex degree was (107.6 ± 8.3)°; and the range of knee motion was (103.5 ± 7.7)°. In PS group, there were 3 males (3 knees) and 32 females (38 knees) aged (65.1 ± 5.9) years, including 33 cases (39 knees) of osteoarthritis and 2 cases (2 knees) of rheumatoid arthritis; BMI was 27.1 ± 4.1; the course of disease was (5.1 ± 4.9) years; HSS score was 60.1 ± 10.4; WOMAC score was 47.9 ± 7.2; the maximum knee flex degree was (108.4 ± 9.7)°; and the range of knee motion was (105.9 ± 11.4)°. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention. No compl ication of ankylosis, blood vessel and nerve injuries, and prosthesis loosening occurred. All patients were followed up for 24-54 months (average 32.8 months). There were no significant differences in the HSS score, WOMAC score, the maximum knee flex degrees, and the range of knee motion at 3, 12, and 24 months after operation between two groups (P gt; 0.05), but there were significant differencesbetween pre- and post-operation (P lt; 0.05). Anterior knee pain occurred in 1 case of HF group and 4 cases of PS group after 24 months, the incidence rates were 3.70% in HF group and 9.76% in PS group, showing significant difference (P lt; 0.05). The X-ray films showed that no lucent zone around prosthesis and no patella baja were observed, and the force l ine was excellent. Conclusion There is no significant difference in the range of knee motion and cl inical scores between the HF prosthesis and the PS prosthesis, but the former’s incidence rate of anterior knee pain is lower.
To investigate the causes and the cl inical treatment methods of postoperative wound compl ications following total knee arthroplasty (TKA). Methods From June 2005 to August 2008, 486 cases (576 knees, including 314 left knees and 262 right knees) underwent primary TKA using standard midl ine incision and medial parapatellar arthrotomy. There were 146 males (172 knees) and 340 females (404 knees) aged 51-86 years old (average 61.3 years old). The duration of disease was 3-35 years. Primary diseases included: 138 cases (156 knees) of rheumatoid arthritis, 282 cases (348 knees) of osteoarthritis, 46 cases (49 knees) of traumatic arthritis, 20 cases (23 knees) of pigmented villonodular synovitis. The factors of etiology, deformity correction, duration of tourniquet use and wound drainage were analyzed to determine the cause of postoperative wound compl ication. Results Postoperatively, 37 cases (43 knees) had wound compl ications and the rate of incidence was 7.5%, including 13 cases (15 knees) of aseptic exudation, 3 cases (4 knees) of fat l iquefaction, 4 cases (4 knees) of subcutaneous hematoma, 8 cases (9 knees) of flap margin necrosis, 6 cases (7 knees) of superficial infection, 3 cases (4 knees) of red swollen joint with increased skin temperature and deepinfection. All 37 patients recoveried after symptomatic treatment. Among those 37 cases, patients with rheumatoidarthritis had a higher incidence rate of wound compl ication than the patients with other primary diseases (P lt; 0.05). Theincidence rate of patients with deformity correction more than or equal to 20 degree was significantly higher than that ofother patients (P lt; 0.05). The duration of using tourniquet was (86 ± 15) minutes for patients with wound compl ication,and (78 ± 8) minutes for patients without wound compl ication, indicating there was a significant difference (P lt; 0.01).Wound compl ication occurred in 22 knees (5.1%) with autologous blood transfusion absorber, 11 knees (11.5%) withnegative pressure attraction, and 10 knees (19.2%) receiving no drainage. The incidence rate of postoperative woundcompl ication in patients without drainage was obviously higher than that in patients with drainage (P lt; 0.05). ConclusionPatients with rheumatoid arthritis are more l ikely to have wound compl ication after TKA. Postoperative wound drainage and short duration of tourniquet appl ication help decrease the incidence of compl ications. It is necessary to make early definitive diagnosis of postoperative wound compl ication, and provide proactive treatment.
Objective To compare the difference of anterior knee pain between mobile-bearing prosthesis and fixedbearing prosthesis after total knee arthroplasty (TKA). Methods Between January 2008 and October 2008, 72 patients withosteoarthritis were treated with primary TKA. All patients were randomly divided into fixed-bearing prosthesis group (n=37)and mobile-bearing prosthesis group (n=35). In fixed-bearing prosthesis group, there were 8 males and 29 females with an average age of 69.6 years (range, 57-76 years), weighing from 55 to 92 kg (mean, 66.7 kg); the locations were the left knee in 20 cases and the right knee in 17 cases; the body mass index (BMI) ranged from 17.6 to 37.3 (mean, 26.2); the disease duration was 3-22 years; the Knee Society Score (KSS) knee score, function score, patellar score, and pain score were 29.4 ± 15.3, 33.4 ± 16.8, 7.2 ± 2.5, and 2.5 ± 2.2, respectively; and the Insall-Salvati (I-S) index was 1.6 ± 0.3. In mobile-bearing prosthesis group, there were 9 males and 26 females with an average age of 68.2 years (range, 58-73 years), weighing from 50 to 86 kg (mean, 67.9 kg); the locations were the left knee in 30 cases and the right knee in 5 cases; the BMI ranged from 18.4 to 34.4 (mean, 25.6); the disease duration was 6-18 years; the KSS knee score, function score, patellar score, and pain score were 30.9 ± 14.7, 31.4 ± 14.4, 6.8 ± 3.1, and 2.0 ± 2.3, respectively; and the I-S index was 1.6 ± 0.2. There was no significant difference in general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention; no deep vein thrombosis of lower l imbs or pulmonary embol ism occurred. All patients were followed up 12-16 months. In mobile-bearing prosthesis group, knee infection occurred in 1 case, dislocation of the knee in 1 case, and cl icking of the knee in 3 cases; in fixed-bearing prosthesis group, cl icking of the knee occurred in 1 case. There was no significant difference in KSS knee score, function score, patellar score, or pain score between 2 groups (P lt; 0.05) at last follow-up; and there was no significant difference in congruence angle, lateral patellofemoralangle, patellar tilt angle, lateral patellar displacement, patellar displacement, or I-S index between 2 groups at last follow-up (P gt; 0.05). Anterior knee pain occurred in 7 cases (18.9%) of the fixed-bearing prosthesis group and in 5 cases (14.3%) of the mobilebearing prosthesis group, showing no significant difference (χ2=0.227, P =0.634). There were significant differences in KSS knee score, function score, patellar score, and I-S index between patients with anterior knee pain and patients without anterior knee pain (P lt; 0.05). Conclusion Fixed-bearing prosthesis and mobile-bearing prosthesis have the same short-term effectiveness and the incidence of anterior knee pain.
Objective To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)． Methods Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared. Results There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred. Conclusion Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.
Objective To summarize the strategies and treatment methods in correcting the maltracking of patellofemoral joints in the total knee arthroplasty (TKA). Methods From January 2000 to May 2007, the methods of releasing lateral retinaculum and tightening medial retinaculum of patellar, adjusting the position of the tibial prothesis properly and shifting the lateral 1/2 insertion inward to the medial side of patellar tendon, and reconstructing the patellar tendon insertion were used in correcting the maltracking of patellofemoral joints when the TKA was conducted for 49 knee joints of 48 cases. All thecases were females, aged 53-76 years old (66.8 on average). The course of disease was 6-23 years (16.2 years on average). Among all the cases, 37 with 38 knee joints were osteoarthritis, and 11 with 11 knee joints were arthritis pauperum. Different degrees of genu valgum and external rotation of knee joints were found in all cases. The genu valgum angle was 23-42° with an average of 33°. The Q angle was 16-23° with an average of 19°. Flexion deformity of knee joints with 8-35° (22° on average) was found in 23 cases. The preoperative KSS knee joint score was 21-51 points (32 points on average), and the function score was 29-45 points (33 points on average). Results All incisions obtained heal ing by first intension. All the patients were followed up for 7-82 months (52 months on average). Genu valgum deformity of knee joints was corrected in all cases. Residual flexion deformity with 5° of knee joints was found in 3 cases. The running track of patellofemoral joints returned to normal in all cases. Laceration or fragmentation was not found in reconstructed patellar l igaments. The postoperative KSS knee joint score was 76-89 points (82 points on average), and the function score was 81-90 points (85 points on average). The X-ray films from the very beginning of post-operation to the end of follow-up showed the prosthesis was normal. Conclusion In correcting the maltracking of patellofemoral joints in TKA, releasing lateral retinaculum and tightening medial retinaculum of patellar, adjusting the position of the tibial prothesis properly, shifting the lateral 1/2 insertion inward to the medial side of patellar tendon and reconstructing the patellar tendon insertion were efficient methods, without any adverse effect on the early rehabilitation training of knee joins.
ObjectiveTo compare the application effects between personal specific instrumentation (PSI) and computer-assisted navigation surgery (CAS) in total knee arthroplasty (TKA). MethodsThe literature comparing the application effects of PSI and CAS in TKA in recent years was widely consulted, and the difference between PSI-TKA and CAS-TKA in operation time, lower limb alignment, blood loss, and knee function were compared. ResultsCompared to CAS-TKA, PSI-TKA simplifies operation procedures and shortens operation time but probably has worse lower limb alignment. It is still controversial in comparison of perioperative blood loss and knee function between two techniques. ConclusionPSI-TKA and CAS-TKA both have advantages and disadvantages, and their differences need to be confirmed by further high-quality clinical trial.
Objective To conduct a systematic bibliometric analysis of recent research on robot-assisted orthopedic surgery, in order to reveal the research trends, hotspots, main contributors, and future development directions in this field. Methods On August 27, 2024, WoSCC (Web of Science Core Collection Database) was searched and relevant literature on robot-assisted orthopedic surgery from 2003 to 2023 was included. Excel 2016, VOSviewer (version 1.6.10), and CiteSpace (version 6.2.R6) were used for data collection and analysis. Results The total citation frequency of 1718 retrieved literature was 28978 times, with an average citation frequency of 16.87 times per article. The total citation frequency of articles in 2019 was the highest (4330 times), and the publication volume in 2023 was the highest (315 articles). Among the top 5 countries in terms of publication volume, the United States had the highest publication volume and total citation frequency, while China ranked second in terms of publication volume, but had the lowest average citation frequency per article. Analysis of cooperation between countries showed that the United States, China, Germany, and other countries had the most cooperation. Babar Kayani’s articles were cited the most frequently. Among the top 10 institutions in terms of publication volume, the Hospital for Special Surgery (United States) had the highest publication volume, the Pennsylvania State System of Higher Education (United States) had the highest total citation frequency for publications, and the average citation frequency of each article published by the University of Pittsburgh (United States) was the highest. The dynamic evolution of research hotspots suggested that early research mainly focused on the combination of traditional surgical techniques and navigation, while in recent years, research had mainly focused on computer-aided surgery, augmented reality, and medical robotics technology. Conclusions In recent years, significant progress has been made in the research of robot-assisted orthopedic surgery, with the United States taking a leading position in this field and having extensive global cooperation. Research hotspots show that with the continuous development of computer-aided surgery, augmented reality, and robotics technology, the field of orthopedic surgery is evolving towards more precise, individualized, and minimally invasive directions.
ObjectiveTo evaluate the effect of the surgeon’s handedness on the distribution of prosthesis during primary total knee arthroplasty (TKA).MethodsA retrospective analysis was performed on 86 patients (100 knees) with primary TKA completed by the same right-handed surgeon between December 2016 and December 2018, including 72 cases of single knee and 14 of bilateral knees. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the operating position of the surgeon and each group had 50 knees. There was no significant difference in gender, age, body mass index, disease duration, clinical diagnosis, preoperative Hospital for Special Surgery (HSS) score, and other general data between the two groups (P>0.05). The operation time and complications were recorded in both groups. The function of knee was evaluated by HSS score. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured by using X-ray film of full-length lower extremity before TKA and at 2 weeks after TKA that were used to evaluate the coronal position of the prosthesis. Posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA) were measured by using lateral X-ray films at 3 months after operation that were used to evaluate the sagittal position of the prosthesis.ResultsThere was no significant difference in operation time between the two groups (t=?1.128, P=0.262). One case of posterior tibial artery thrombosis occurred in the dominant group, and 1 case of poor healing of the incision occurred in each of the dominant group and the non-dominant group. Patients in both groups were followed up 12-34 months with an average of 22.0 months. The HSS scores at last follow-up were 87.2±4.3 in the dominant group and 86.8±5.0 in the non-dominant group. There was no significant difference between the two groups (t=0.471, P=0.639). No complications such as periprosthetic infection, prosthetic loosening, or periprosthetic fracture occurred during follow-up. There was no significant difference in the HKA, mLDFA, and mMPTA between the two groups before and after operation (P>0.05). The differences in the incidence of sagittal femoral prosthesis malposition and PDFA between the two groups were significant (P<0.05); however, there was no significant difference in the PPTA, the rate of femoral prosthesis distributed in the neutral position, the incidence of over-flexed femoral prosthesis, and the incidence of anterior femoral notch (P>0.05).ConclusionThe surgeon’s handedness is one of the factors affecting the placement of the sagittal femoral prosthesis in primary TKA. The incidence of sagittal femoral prosthesis malposition could increase when the surgeon performs on the non-dominant side.
Objective To investigate a modified robotized hydraulictensor for management of the ligament balance in the total knee arthroplasty. Methods The effect of the modified robotized hydraulic tensor on the mechanical behaviour of the ligament system balance in the total knee arthroplasty was analyzed andthe related information was obtained. Results The robotized hydraulic tensor acted as a tensorsensor system, which could assist the surgeon by providing thequantitative information to align the lower limb in extension, equalize the articular spaces in extension and flexion, balance the internal and external forces, and define the femoral component rotation, and by providing the information toplan the releasing of the soft tissues and the rotating of the femoral component. Conclusion The modified robotized hydraulic tensor can enable the surgeon to properly manage the ligament balance in the total knee arthroplasty.